scholarly journals Telemedicine: A Paradigm Shift in Healthcare in the wake of COVID-19 in India

2020 ◽  
Author(s):  
Ria Saha ◽  
Vinoth Gnana Chellaiyan
Keyword(s):  
Disease Transmission ◽  
Healthcare Services ◽  
National Guidelines ◽  
Medical Practitioners ◽  
Regulatory Guidelines ◽  
Risk Of Disease ◽  
Wide Scale ◽  
The Government ◽  
Institutional Challenges

The COVID-19 pandemic has severely affected the delivery of essential healthcare services in India. The massive disruption of the routine healthcare services had been circumvented to a certain extent with the application of telemedicine. In the wake of the COVID-19 pandemic, the Government of India has issued regulatory guidelines and approved Registered Medical Practitioners (RMP) to adopt the usage of teleconsultation service which can be real-time or asynchronous to minimise the risk of disease transmission. The commentary provides an in-depth review of the regulatory guidelines implemented by the Government of India and discusses the inherent structural and fundamental challenges associated with its wide scale adoption, accessibility, and utilisation. Though the Government of India had issued national guidelines to promote safe and effective usage of telemedicine practice, there remains certain primary structural, technical and institutional challenges regarding expansion of uninterrupted services to periurban and rural peripheral health facilities and its nationwide sustainability. The article demands the attention of the policymakers and relevant stakeholders to identify the inherent bottlenecks intrinsic to the guidelines and amend the regulatory framework accordingly to ensure its long-term sustainability.

scholarly journals Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection

2021 ◽  
Vol 6 (1) ◽  
pp. e000591
Author(s):  
Heather Carmichael ◽  
Franklin L Wright ◽  
Robert C McIntyre ◽  
Thomas Vogler ◽  
Shane Urban ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Disease Transmission ◽  
Percutaneous Tracheostomy ◽  
Ventilator Weaning ◽  
High Rate ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Risk Of Disease ◽  
Short Time

BackgroundSince the outset of the coronavirus disease 2019 (COVID-19) pandemic, published tracheostomy guidelines have generally recommended deferral of the procedure beyond the initial weeks of intubation given high mortality as well as concerns about transmission of the infection to providers. It is unclear whether tracheostomy in patients with COVID-19 infection facilitates ventilator weaning, and long-term outcomes are not yet reported in the literature.MethodsThis is a retrospective study of tracheostomy outcomes in patients with COVID-19 infection at a single-center academic tertiary referral intensive care unit. Patients underwent percutaneous tracheostomy at the bedside; the procedure was performed with limited staffing to reduce risk of disease transmission.ResultsBetween March 1 and June 30, 2020, a total of 206 patients with COVID-19 infection required mechanical ventilation and 26 underwent tracheostomy at a mean of 25±5 days after initial intubation. Overall, 81% of tracheostomy patients were liberated from the ventilator at a mean of 9±6 days postprocedure, and 54% were decannulated prior to hospital discharge at a mean of 21±10 days postprocedure. Sedation and pain medication requirements decreased significantly in the week after the procedure. In-hospital mortality was 15%. Among tracheostomy survivors, 68% were discharged to a facility.DiscussionThe management of patients with COVID-19 related respiratory failure can be challenging due to prolonged ventilator dependency. In our initial experience, outcomes post-tracheostomy in this population are encouraging, with short time to liberation from the ventilator, a high rate of decannulation prior to hospital discharge, and similar mortality to tracheostomy performed for other indications. Barriers to weaning ventilation in this cohort may be high sedation needs and ventilator dyssynchrony.Level of evidenceLevel V—Therapeutic/care management.

Attitudes, Beliefs, and Practices Regarding Asthma Care Among Providers and Adult Asthmatics in Imperial County

2003 ◽  
Vol 1 (2) ◽  
pp. 88-100
Author(s):  
Paula Kriner ◽  
Yolanda Bernal
Keyword(s):  
Focus Groups ◽  
Cultural Beliefs ◽  
National Guidelines ◽  
Medical Practitioners ◽  
Beliefs And Practices ◽  
Attitudes And Practices ◽  
Hospitalization Rates ◽  
Adult Asthmatic ◽  
Asthma Hospitalization ◽  
Survey Results

Asthma is a major cause of morbidity in children and adults. Imperial County has reported among the highest asthma hospitalization rates in the state. Factors such as poverty, access to care, poor selfmanagement skills, and ethnocultural beliefs may influence asthma exacerbations. Provider and adult asthmatic attitudes, beliefs, and practices regarding asthma were examined using a mixed-methods approach: a survey to evaluate provider conformance with national guidelines, and focus groups targeting medical practitioners and adult asthmatics. Half of all providers who treat asthmatics completed a self-administered survey about asthma diagnosis; clinical monitoring of patients; treatment; patient education; and practice guidelines. Provider focus groups further explored survey results. Adult asthmatics participated in Spanishlanguage focus groups exploring cultural beliefs, attitudes, and practices. El asma es la mayor causa de morbilidad entre niños y adultos. El Condado de Imperial ha reportado las tazas más altas de hospitalización a causa de asma en el estado. Factores como la pobreza, acceso a cuidado médico, falta de experiencia sobre como manejar la enfermedad, y creencias étnicas y culturales pueden tener una influencia en las exacerbaciones del asma. Las actitudes, creencias, y prácticas de proveedores de atención médica y adultos concerniente al asma fueron examinadas utilizando varios métodos: una encuesta con el fin de evaluar el nivel de conformidad de los proveedores según las pautas establecidas a nivel nacional, y grupos foco con médicos y adultos con asma. La mitad de los proveedores que proveen atención a asmáticos completaron una encuesta acerca del diagnosis de asma; el monitoreo clínico de los pacientes; administración de tratamiento; educación a los pacientes; y pautas establecidas para proveer atención a pacientes con asma. Los grupos foco con los proveedores exploraron aun más los resultados de las encuestas. Los adultos con asma participaron en grupos foco dirigidos en español para explorar más a fondo las creencias culturales, actitudes y prácticas.

Periodic monitoring of vampire bats and rabies: a new framework for animal restoration projects in the Neotropics

2020 ◽  
Author(s):  
Fernando Gonçalves ◽  
Daniel G. Streicker ◽  
Mauro Galetti
Keyword(s):  
Disease Transmission ◽  
Lessons Learned ◽  
Multidisciplinary Teams ◽  
Risk Area ◽  
Food Web Structure ◽  
Land Bridge ◽  
High Risk Area ◽  
Restoration Project ◽  
Vampire Bats

Nowadays, restoration project might lead to increased public engagement and enthusiasm for biodiversity and is receiving increased media attention in major newspapers, TED talks and the scientific literature. However, empirical research on restoration project is rare, fragmented, and geographically biased and long-term studies that monitor indirect and unexpected effects are needed to support future management decisions especially in the Neotropical area. Changes in animal population dynamics and community composition following species (re)introduction may have unanticipated consequences for a variety of downstream ecosystem processes, including food web structure, predator-prey systems and infectious disease transmission. Recently, an unprecedented study in Brazil showed changes in vampire bat feeding following a rewilding project and further transformed the land-bridge island into a high-risk area for rabies transmission. Due the lessons learned from ongoing project, we present a novel approach on how to anticipate, monitor, and mitigate the vampire bats and rabies in rewilding projects. We pinpoint a series of precautions and the need for long-term monitoring of vampire bats and rabies responses to rewilding projects and highlighted the importance of multidisciplinary teams of scientist and managers focusing on prevention educational program of rabies risk transmitted by bats. In addition, monitoring the relative abundance of vampire bats, considering reproductive control by sterilization and oral vaccines that autonomously transfer among bats would reduce the probability, size and duration of rabies outbreaks. The rewilding assessment framework presented here responds to calls to better integrate the science and practice of rewilding and also could be used for long-term studying of bat-transmitted pathogen in the Neotropical area as the region is considered a geographic hotspots of “missing bat zoonoses”.

Connecting Crop Nutrient Use Efficiency to Future Soil Productivity

2018 ◽  
Vol 102 (4) ◽  
pp. 8-10
Author(s):  
Fernando García ◽  
Andrés Grasso ◽  
María González Sanjuan ◽  
Adrián Correndo ◽  
Fernando Salvagiotti
Keyword(s):  
Nutrient Management ◽  
Nutrient Use Efficiency ◽  
Management Strategies ◽  
Crop Productivity ◽  
Soil Productivity ◽  
Nutrient Use ◽  
Grain Crop ◽  
Wide Scale ◽  
Use Efficiency

Trends over the past 25 years indicate that Argentina’s growth in its grain crop productivity has largely been supported by the depletion of the extensive fertility of its Pampean soils. Long-term research provides insight into sustainable nutrient management strategies ready for wide-scale adoption.

Negative Media Effects and Islamic Remedies (Penyelesaian Kepada Kesan Negatif Media Menurut Perspektif Islam)

2010 ◽  
Vol 7 (2) ◽  
pp. 215
Author(s):  
Mohd. Shuhaimi Ishak
Keyword(s):  
Public Relations ◽  
Social Influences ◽  
The Political ◽  
Negative Effects ◽  
Essential Form ◽  
The Media ◽  
The Government ◽  
Effects Of Media ◽  
Political Economic

 Abstract Generally speaking, media is extensively used as the means to disseminate news and information pertaining to business, social, political and religious concerns. A portion of the time and space of media has now become an important device to generate economic and social activities that include advertising, marketing, recreation and entertainment. The Government regards them as an essential form of relaying news and information to its citizens and at the same time utilizes them as a powerful public relations’ mechanism. The effects of media are many and diverse, which can either be short or long term depending on the news and information. The effects of media can be found on various fronts, ranging from the political, economic and social, to even religious spheres. Some of the negative effects arising from the media are cultural and social influences, crimes and violence, sexual obscenities and pornography as well as liberalistic and extreme ideologies. This paper sheds light on these issues and draws principles from Islam to overcome them. Islam as revealed to humanity contains the necessary guidelines to nurture and mould the personality of individuals and shape them into good servants. Key Words: Media, Negative Effects, Means, Islam and Principles. Abstrak Secara umum, media secara meluas digunakan sebagai sarana untuk menyebarkan berita dan maklumat yang berkaitan dengan perniagaan, kemasyarakatan, pertimbangan politik dan agama. Sebahagian dari ruang dan masa media kini telah menjadi peranti penting untuk menghasilkan kegiatan ekonomi dan sosial yang meliputi pengiklanan, pemasaran, rekreasi dan hiburan. Kerajaan menganggap sarana-sarana ini sebagai wadah penting untuk menyampaikan berita dan maklumat kepada warganya dan pada masa yang sama juga menggunakannya sebagai mekanisme perhubungan awam yang berpengaruh. Pengaruh media sangat banyak dan pelbagai, samada berbentuk jangka pendek atau panjang bergantung kepada berita dan maklumat yang brekenaan. Kesan dari media boleh didapati mempengaruhi pelbagai aspek, bermula dari bidang politik, ekonomi, sosial bahkan juga agama. Beberapa kesan negatif yang timbul dari media ialah pengaruhnya terhadap budaya dan sosial, jenayah dan keganasan, kelucahan seksual dan pornografi serta ideologi yang liberal dan ekstrim. Kertas ini menyoroti isu-isu ini dan cuba mengambil prinsip-prinsip dari ajaran Islam untuk mengatasinya. Tujuan Islam itu sendiri diturunkan kepada umat manusia ialah untuk menjadi pedoman yang diperlukan untuk membina dan membentuk keperibadian individu dan menjadikan manusia hamba yang taat kepada Tuhannya. Kata Kunci: Media, Kesan Negatif, Cara-cara, Islam dan Prinsip-prinsip.

INTRAUTERINE GROWTH RETARDATION - A REVIEW ARTICLE

2018 ◽  
pp. 184-195
Author(s):  
Minh Son Pham ◽  
Vu Quoc Huy Nguyen ◽  
Dinh Vinh Tran
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Growth Potential ◽  
National Guidelines ◽  
Intrauterine Growth ◽  
No Gold Standard

Small for gestational age (SGA) and fetal growth restriction (FGR) is difficult to define exactly. In this pregnancy condition, the fetus does not reach its biological growth potential as a consequence of impaired placental function, which may be because of a variety of factors. Fetuses with FGR are at risk for perinatal morbidity and mortality, and poor long-term health outcomes, such as impaired neurological and cognitive development, and cardiovascular and endocrine diseases in adulthood. At present no gold standard for the diagnosis of SGA/FGR exists. The first aim of this review is to: summarize areas of consensus and controversy between recently published national guidelines on small for gestational age or fetal growth restriction; highlight any recent evidence that should be incorporated into existing guidelines. Another aim to summary a number of interventions which are being developed or coming through to clinical trial in an attempt to improve fetal growth in placental insufficiency. Key words: fetal growth restriction (FGR), Small for gestational age (SGA)

Corrupt Practices in the Public Health Sector: A Focus on Metropolitan Local Government Areas of Kano State, Nigeria

2020 ◽  
Vol 18 (2) ◽  
pp. 149
Author(s):  
Mohammed Mustapha Namadi
Keyword(s):  
Public Health ◽  
Local Government ◽  
Health Sector ◽  
Sampling Technique ◽  
Healthcare Services ◽  
Healthcare Sector ◽  
Healthcare Provision ◽  
The Public ◽  
Public Health Sector ◽  
The Government

Corruption is pervasive in Nigeria at all levels. Thus, despite recent gains in healthcare provision, the health sector faces numerous corruption related challenges. This study aims at examining areas of corruption in the health sector with specific focus on its types and nature. A sample size of 480 respondents aged 18 years and above was drawn from the eight Metropolitan Local Government Areas of Kano State, using the multistage sampling technique. The results revealed evidence of corrupt practices including those related to unnecessary-absenteeism, diversion of patients from the public health facilities to the private sector, diverting money meant for the purchase of equipment, fuel and diesel, bribery, stealing of medications, fraud, misappropriation of medications and unjustifiable reimbursement claims. In order to resolve the problem of corrupt practices in the healthcare sector, the study recommended the need for enforcement of appropriate code of ethics guiding the conduct of the health professionals, adoption of anti-corruption strategies, and strengthening the government monitoring system to check corruption in public health sector in order to ensure equitable access to healthcare services among the under-privileged people in the society.

СОХРАНЕНИЕ ПРИВЕРЖЕННОСТИ К ТЕРАПИИ КАК ГАРАНТИЯ ЭФФЕКТИВНОСТИ СЛИТ

2019 ◽  
Author(s):  
K.S. Pavlova ◽  
D.S. Mdinaradze
Keyword(s):  
Allergic Diseases ◽  
Atopic Asthma ◽  
National Guidelines ◽  
Allergen Specific Immunotherapy ◽  
Dose Dependent ◽  
Methods Of Treatment ◽  
Choice Of Therapy ◽  
Dose Dependent Effect ◽  
Reduced Adherence

По данным ВОЗ, рекомендации врача выполняют не более 50 пациентов. В конечном итоге это приводит к снижению или отсутствию эффекта от назначаемого лечения. В связи с этим во всех последних международных и национальных руководствах говорится о необходимости учета предпочтений пациента при выборе терапии. Аллерген-специфическая иммунотерапия (АСИТ) является одним из основных методов лечения аллергических заболеваний, таких как аллергический ринит, конъюнктивит и атопическая бронхиальная астма, обладает болезнь-модифицирующими свойствами и долгосрочным эффектом после окончания лечения. АСИТ относится к профилактическому и продолжительному методу (рекомендовано на протяжении не менее 3 лет), что часто является причиной снижения приверженности к терапии. В различных исследованиях подтвержден зависимый от дозы аллергена эффект АСИТ, а следовательно, изменение режимов или сокращение сроков терапии могут влиять на конечный результат. При недостаточной эффективности АСИТ необходимо в первую очередь рассматривать вероятность низкого комплаенса. Сублингвальная АСИТ (СЛИТ) требует от пациента высокой вовлеченности в процесс лечения. Задачей врача в данном случае становится повышение терапевтического сотрудничества как одного из важнейших факторов обеспечения эффективности СЛИТ. Основными способами в данном случае являются улучшение понимания пациентом цели терапии и регулярный контроль со стороны врача.According to WHO at last 50 of the patient dont follow doctors recommendations. Ultimately, this leads to a decrease or absence of the treatment effect. In this regard, all the latest international and national guidelines mention the need to take into account the patients preferences in the choice of therapy. Allergen-specific immunotherapy (AIT) is one of the main methods of treatment of allergic diseases such as allergic rhinitis, allergic conjunctivitis and atopic asthma, and has disease modifying properties and the long-term efficacy after stop treatment. AIT refers to a preventive and long-term method (recommended for at least 3 years), that is often the cause of reduced adherence to therapy. Various studies have confirmed the dose-dependent effect of AIT, and, consequently, changes in regimens or shortening of therapy may affect the end result. In case of insufficient effectiveness of AIT, the probability of low compliance should be considered first of all. Sublingual AIT (SLIT) requires the patient to be highly involved in the treatment process. The task of the doctor in this case is increasing therapeutic cooperation, as one of the most important factors to ensure the effectiveness of SLIT. The main methods in this case are to improve the patients understanding of the purpose of the therapy and regular monitoring by the doctor.

The Mortality Rate of COVID-19 in Iraq Compare with Iran and Turkey, its Association with the Bacillus Calmette-Guerin (BCG) vaccine and the Iraqi Preparedness Plan Prior to Pandemics. (Preprint)

2020 ◽  
Author(s):  
Rawand Essa
Keyword(s):  
Middle East ◽  
Mortality Rate ◽  
Daily Basis ◽  
Bcg Vaccine ◽  
Critical Position ◽  
Preparedness Plan ◽  
Contagious Diseases ◽  
History Of ◽  
The Government

BACKGROUND In the span of COVID-19, the mortality rate has been different from one country to another. As a country in the Middle East Iraq has a critical position, lies between Iran and Turkey while both countries coronavirus cases increase on daily basis, while Iranian mortality rate record is high similar to Turkey. After Wuhan city of China, Lombard of Italy, Qum city in Iran has the highest number of COVID-19 as a first country in the Middle East. OBJECTIVE aim of this study is to show the effect of BCG vaccine during pandemic diseases, especially nowadays at the time of COVID-19. One of the crucial observations is the government preparedness and strategic planning prior pandemics, in which the BCG vaccine is an attenuated live vaccine for control of tuberculosis (TB). BCG vaccine has a non-specific immune effect that is used against pathogens like bacteria and viruses, through the promotion of pro-inflammatory cytokines' secretion. METHODS An epidemiological study has been performed, and it shows that some countries are more prone to contagious diseases like COVID-19, regardless of the main cultural, religious, societal similarities among the three mentioned countries. The information data has been collected from WHO reports and worldometer in 18 February 2020 to 10 May 2020. Regarding the efficacy of the BCG vaccine, relevant data has been retrieved from Google scholar, Pub-med and BCG world-atlas. RESULTS COVID-19 mortality rates are at peak in Iran and Turkey while the mortality rate is very low in Iraq, while the patients that died in Iraq all had history of other long-term diseases as heart disease, blood pressure, cancer etc. CONCLUSIONS From the experiences of the three countries in the life span of COVID-19, the historical plan of BCG vaccine in Iraq in cooperation with WHO since the last decades it shows that COVID-19 mortality rate is lower than other countries due to the early vaccination of the Iraqis, otherwise Iraq is more fragile than Iran and Turkey due to the poor conditions of Iraq in terms of economics, politics, war and other aspects.

Telemedicine (or Teleconsultation?) Practice Guidelines of India: A Game changer or a half-hearted attempt amid COVID-19? (Preprint)

2020 ◽  
Author(s):  
Venkatesh U ◽  
Aravind Gandhi P
Keyword(s):  
Health Care ◽  
Practice Guidelines ◽  
Health Care Workers ◽  
Data Security ◽  
Patient Relationship ◽  
Medical Practitioners ◽  
Care Workers ◽  
The Government ◽  
First Time ◽  
Game Changer

UNSTRUCTURED Telemedicine is where health care intersects with Information Technology. In India, there has been no statutory regulations or official guidelines, specific for Telemedicine practice and allied matters, so far. For the first time, Government of India has released Telemedicine Practice Guidelines for Registered Medical Practitioners on March 25, 2020, amid the COVID-19 outbreak. Through this paper, we would like to initiate the discussion on the features of the guidelines, limitations, and its significance in times of COVID-19 pandemic. The guidelines are with a restricted scope for providing medical consultation to patients, excluding other aspects of Telemedicine such as research and evaluation, and the continuing education of health-care workers. The guidelines have elaborated on the eligibility for practicing Telemedicine in India, the modes and types of Teleconsultation, delved into doctor-patient relationship, consent, & management protocols, touched upon the data security & privacy aspects of the Teleconsultation. After releasing the guidelines, Telescreening of public for COVID-19 symptoms is being advocated by the Government of India. COVID-19 National Teleconsultation Centre (CoNTeC) has been initiated, which connects the doctors across the India to AIIMS in real-time for accessing expert guidance on treatment of the COVID-19 patients.

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